The Clinical journal of pain
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Comparative Study
Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability.
More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). ⋯ The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.
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Comparative Study
Electronic momentary assessment in chronic pain I: psychological pain responses as predictors of pain intensity.
Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7,100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed in this regard. ⋯ Exaggerated negative interpretations of pain, and fear that movement will induce or increase pain strongly predicted CPD pain intensity. Spousal responses-assessed only when the spouse was with the patient who at that moment was in actual pain-may more strongly affect immobility due to pain than pain intensity per se (see part II of the study). The findings substantiate the importance of catastrophizing, fear and vigilance identified primarily in low back pain and extend this to other forms of chronic pain. The compelling evidence of momentary within-patients differences underscores that these must be accounted for in chronic pain research and practice.
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The ways in which people adjust to chronic pain has been partly attributed to pre-existing personality traits, but most evidence to date is from cross-sectional studies and mainly with arthritis groups. The present study examined the effects of 5 personality dimensions on measures of pain-related beliefs and catastrophizing assessed 9 months apart with a heterogeneous chronic pain sample. ⋯ Of the 5 personality dimensions studied, only neuroticism was related to the pain-related variables. Multiple hierarchical regression analyses revealed that neuroticism was a significant predictor of residualized change in pain self-efficacy beliefs and pain control appraisals over the time of the study, after controlling for initial values of both constructs. However, the effects were small, suggesting that other factors play a role in the determination of such beliefs, in addition to neuroticism. In contrast, neuroticism was not a significant predictor of residualized change in catastrophizing responses over the same period. The findings provide partial support for the hypothesis that pre-existing personality traits place some patients at risk for poor adjustment to chronic pain.
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Case Reports
Basal blood flow in complex regional pain syndrome does not necessarily indicate vasoconstrictor nerve activity.
To quantitatively investigate simultaneous skin blood flow and sweating in a patient with complex regional pain syndrome. ⋯ Although sympathetic nerve activity (sympathetic flow response) appeared greater on one side, basal blood flow was also greater on that side. These contradictory results suggest that some factor or factors increase basal blood flow despite a higher sympathetic nerve tone on the side. Comparing basal blood flow on one side to the contralateral side does not necessarily indicate lesser vasoconstrictor nerve activity on that side. Advantages of simultaneous measurement of skin blood flow and sweating with a single probe may make the method useful.